Universität zu Köln

Hohmann, Christopher, Hohnloser, Stefan H., Jacob, Josephine, Walker, Ochen, Baldus, Stephan and Pfister, Roman (2019). Non-Vitamin K Oral Anticoagulants in Comparison to Phenprocoumon in Geriatric and Non-Geriatric Patients with Non-Valvular Atrial Fibrillation. Thromb. Haemost., 119 (6). S. 971 - 981. STUTTGART: GEORG THIEME VERLAG KG. ISSN 2567-689X

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Abstract

Geriatric characteristics such as high age, multi-morbidity, polypharmacy and frailty are common in patients with atrial fibrillation (AF). In a retrospective study using a German claims database, effectiveness (ischaemic stroke/systemic embolism) and safety (intracerebral, gastrointestinal and major extracranial bleeding) were compared in patients with non-valvular AF starting non-vitamin K oral antagonists (NOACs) (apixaban, dabigatran and rivaroxaban) and phenprocoumon. Cox proportional hazards models were used to calculate adjusted hazard ratios, and interaction terms of the treatment group and geriatric status (defined by age >= 75 years, frailty,>= 4 co-morbidities and polypharmacy) were entered into the model. A total of 42,562 and 27,939 patients initiated NOAC and phenprocoumon treatment (mean age 74 years +/- 11, 51% male) with a follow-up time of 147,785 person-years. Note that 52.9% of patients were elderly, 50.8% were frail, 37.0% were co-morbid and 46.5% had polypharmacy. NOAC use was not associated with effectiveness and gastrointestinal bleeding, neither in geriatric nor in non-geriatric patients. The hazard of major extracranial and intracranial bleeding was significantly decreased for NOAC use, with similar risk reduction in geriatric and non-geriatric patients: major extracranial bleeding 0.70 (95% confidence interval [CI], 0.56-0.87) to 0.73 (95% CI, 0.60-0.89) for the geriatric groups and 0.71 (95% CI, 0.56-0.93) to 0.76 (0.59-0.98) for the non-geriatric groups ( p -values for interaction>0.6); and intracranial bleeding 0.52 (95% CI, 0.39-0.69) to 0.59 (95% CI, 0.47-0.73) for the geriatric groups and 0.54 (95% CI, 0.37-0.79) to 0.65 (95% CI, 0.49-0.86) for the non-geriatric groups ( p -values for interaction>0.2). Hence, NOACs showed similar effectiveness and superior safety in geriatric and non-geriatric patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohmann, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED Hohnloser, Stefan H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jacob, Josephine UNSPECIFIED UNSPECIFIED UNSPECIFIED Walker, Ochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-146038
DOI:	10.1055/s-0039-1683422
Journal or Publication Title:	Thromb. Haemost.
Volume:	119
Number:	6
Page Range:	S. 971 - 981
Date:	2019
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	2567-689X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STROKE PREVENTION; ANTITHROMBOTIC THERAPY; ELDERLY-PATIENTS; POSITION PAPER; WARFARIN; FRAILTY; SAFETY; APIXABAN; EFFICACY; RISK Multiple languages Hematology; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14603